Q:  Meds While Breastfeeding

I have three children and I am pregnant with the third.  I have breastfed all three for a few months. I have a manic episode and then have to stop nursing and take medication.  Is there a drug that I can take and safely breastfeed a baby??  I have the best results with lithium (eskalith).


Dear Susan -- 
The American Academy of Pediatrics has okayed Depakote for use in pregnancy.  There are some mood experts who think that is based on too little safety data.  Some Depakote gets across to the baby, and it's really tricky figuring out how much overall.  Carbamazepine has also generally been considered compatible with breastfeeding.  

Here are three articles which reflect these points of view: 

1. A nice review

2. Details of six cases of Depakote and the baby's levels. 

3. Another recent review, a bit more technical. 

As you'll see in these articles, e.g. just by reading the abstracts that are linked here, lithium is out as an option.  Of course, you'll need to review all of this with your doctor.  Good luck with your pregnancy and your treatment. 

Dr. Phelps